Medication Therapy Management for Texas MediCAID Patients With Asthma and Chronic Obstructive Pulmonary Disease-A Pilot Study.

BACKGROUND: Pharmacists can play an important role in providing medication therapy management (MTM) services, which focus on appropriate medication use. This pilot study aimed to describe pharmacists' MTM service provision, results/outcomes of pharmacists' recommendations and resolution/acceptance rate among patients with high-risk asthma and/or chronic obstructive pulmonary disease (COPD). METHODS: This was a prospective descriptive study of MTM services provided by community pharmacists to Texas Medicaid patients (5-63 years) with "high risk" asthma or COPD. Patients received in-person and telephone consultations that included medication review, asthma control test assessment, and education on adherence and proper medication/device use. Data extracted from MTM software was used to describe: reasons for MTM services, type of pharmacists' interventions, outcomes of pharmacists' recommendations and acceptance rate. RESULTS: Twenty-eight pharmacists provided 139 MTM interventions with 63 patients (2.2 interventions per patient). The most frequent intervention reason was complex drug therapy (53.2%), underuse of medication (8.6%), need for drug therapy (8.6%), new or changed prescription therapy (6.5%), and administration technique (5.0%). The resolution rate was 77.7%. Patient and prescriber, respectively, refused recommendation in 12% and 6% of the interventions. Outcomes included comprehensive medication review (46.7%), improved adherence (6.5%), therapeutic success (6.5%), improved administration technique (5.0%), and initiation of new therapy (5.0%). CONCLUSION: Through the provision of MTM, pharmacists were able to identify and intervene with medication-related problems. These interventions are instrumental in helping patients better manage their asthma/COPD. The high resolution rate was encouraging. Larger scale studies are needed to assess clinical and economic outcomes.

The Hispanic Diabetes Management Program: Impact of community pharmacists on clinical outcomes.

OBJECTIVE: To assess the impact of community pharmacists on clinical outcomes in Hispanic patients with type 2 diabetes. METHODS: 126 patients were enrolled in this longitudinal pre/post cohort study that took place in nine community and four workplace pharmacies in San Antonio, TX. Pharmacists provided education, point-of-care testing for glycemic and metabolic parameters, clinical assessment, goal setting, and drug therapy management with physicians. Study outcomes were changes in glycosylated hemoglobin (A1C) and accompanying metabolic parameters (blood pressure, lipid parameters, and body mass index) during a 1-year time frame. RESULTS: In the overall cohort, A1C was not reduced significantly from baseline to 12 months (7.8% vs. 7.6%, P = 0.516). However, statistically significant reductions occurred for fasting plasma glucose, triglycerides, and diastolic blood pressure. None of the other parameters was affected significantly. In the subgroup of patients not at target values at baseline, significant reductions occurred for A1C (9.2% vs. 8.6%, P = 0.001), systolic blood pressure (147 vs. 143 mm Hg, P = 0.031), diastolic blood pressure (91 vs. 87 mm Hg, P < 0.001), triglycerides (259 vs. 219 mg/dL, P < 0.001), LDL cholesterol (139 vs. 123 mg/dL, P < 0.001), and total cholesterol (237 vs. 222 mg/dL, P = 0.008). CONCLUSION: Interventions performed by community pharmacists are effective in improving clinical outcomes in a Hispanic cohort with diabetes. Pharmacists' efforts were most successful in patients not at target glycemic and metabolic levels.

Texas pharmacists' opinions about and plans for provision of medication therapy management services.

OBJECTIVES: To determine pharmacist awareness of medication therapy management (MTM), confidence in and intentions to provide MTM, related training needs, and barriers to MTM provision; and to assess pharmacist and practice site characteristics that are related to confidence in providing MTM. DESIGN: Nonexperimental cross-sectional study. SETTING: May 2006 in Texas. PARTICIPANTS: 1,833 Texas community pharmacists who were affiliated with the Texas Pharmacy Association. INTERVENTION: an anonymous, self-administered online survey was e-mailed to participants. MAIN OUTCOME MEASURES: Awareness of MTM legislation, confidence in providing MTM, intentions to provide MTM, and barriers to MTM provision. Pharmacist and practice site characteristics were also collected. RESULTS: The response rate was 11.8% (n = 157). Overall, pharmacists (>75%) were aware of the three criteria for targeted beneficiaries. They were confident in providing medication therapy review (MTR), creating a personal medication record (PMR), and performing intervention and referral but were only somewhat confident in creating a medication action plan. Pharmacists disagreed or were neutral about having adequate documentation systems for MTM. The majority of respondents intend to become MTM providers (74%) and were interested in additional training (78%). Independent pharmacists, those with adequate documentation systems, and those who had previously provided patient care services were more confident regarding MTM provision. CONCLUSION: Pharmacist intentions to provide MTM indicate that they are eager to expand their roles as patient care providers. Pharmacist confidence in providing MTR, creating a PMR, and performing the intervention and referral suggest that pharmacists already have many of the skills necessary to provide MTM; however, more education about creating action plans and using documentation systems may help pharmacists become successful MTM providers.